Thromboprophylaxis in spinal surgery : a survey of current practice in South Africa

Abstract:

BACKGROUND : Patients undergoing spinal surgery are at risk of developing venous thromboembolism (VTE)
because of co-morbidities and immobilisation, but the morbidity of bleeding and haematoma formation complicates
prophylaxis. A balance between VTE prevention and haematoma formation is therefore critical. Adding to
the complexity is that there are currently no clear guidelines on managing these patients and little evidence in the
literature. In order to improve management, it is imperative to first establish the current practice of thromboprophylaxis
in spinal surgery in South Africa.
METHODS : A survey of surgeons’ peri-operative thromboprophylactic management was conducted with 112 spinal
surgeons.
RESULTS : The results indicated that a large group of surgeons did not follow a standardised protocol. Mechanical
prophylaxis was not used optimally and more surgeons used chemical prophylaxis routinely than mechanical
prophylaxis. The surgeons mostly agreed on the type of chemical prophylaxis used and the time of
commencement thereof. Contrary to the literature, the surgeons in this study did not differentiate between the
surgical approaches used.
CONCLUSION : There is currently no consensus on the management of thromboprophylaxis, as evident from the
varying responses regarding treatment and complications. It is clear that mechanical prophylaxis is currently
under-utilised. Spinal surgeons would benefit from a standardised protocol, and the vast majority of participants
in the study agreed with this recommendation.